Posted by Carl Mays on Sat, Jan 10, 2009 @ 11:47 PM
If you are not aware and prepared for the 2009 cardiology billing and coding changes you may be leaving a lot of money uncollected.
The 2009 cardiology coding and billing changes are the most significant that have been seen since the mid 1990s.
Cardiology practices were hit harder than the average physician by this year's changes (with a 2% reduction in Medicare fees instead of the 1% increase seen by the average physician) driven in large part by changes that will impact imaging performed in the office.
Keep in mind the 2% reduction is an average number. Some practices will be well above this (especially heavy users of echo services) and others will actually see fee increases.
Here are examples of some of the upcoming changes:
- Significant changes in the codes used for follow-up on implanted devices (all of the old codes have been replaced) and external devices. The updated codes include new codes for interrogation and reprogramming of ICM and ICD devices, Pacemaker and Loop recorders.
- Global periods related to device follow-up now include global periods of 30 or 90 days. The new codes are now service specific (i.e., either an interrogation evaluation of a programming evaluation).
- Wearable cardiac telemetry devices (for instance Cardionet type service) now have specific codes. You no longer bill with an unlisted code. These new codes include the complication of global periods.
- The echo services are also seeing new codes. When you do an echo with a Doppler and color flow you'll have a new code to submit that bundles these services into one code. The same is true for a new stress echo code that bundles the stress test code and stress echo into one code.
These changes are far greater than the normally "tweaking" that occurs at the beginning of each year. If you cardiology billing department is not fully aware of the changes and how to respond to these changes it could have a significant negative impact on your practice. Be sure to invest in the proper training, coding resources and billing system upgrades to be prepared for 2009 cardiology billing.
Copyright 2009 by Carl Mays II
Posted by Carl Mays on Tue, Dec 16, 2008 @ 09:19 PM
Medical practices lose money every single day (often over 20 percent of their realizable income) because they are not utilizing medical billing specialists, technologies, processes and management that can compete with insurance companies.
As physicians are taking into consideration the use of medical billing services to stop the hemorrhaging of cash from their practices, they are faced with a broad range of options. On the diminutive end of the spectrum are home-based medical billers. On the opposite end of the spectrum are medical billing companies that employ hundreds of medical billers and have thousands of clients.
In thinking through the billing options available, it is essential to understand that medical billing is complicated and requires deep expertise and expansive experience. When a specialty is involved, such as cardiology billing, the requirements for success become even harder to realize. Success requires that the medical billing company have a team that is knowledgeable in the complex rules utilized by insurance companies to judge cardiologists' medical claims.
With cardiologists facing ever increasing costs they must insure that money is not being left on the table because they have a billing company that is not a cardiac billing expert. Cardiologists must also be aware that that many billing companies that claim cardio billing expertise actually outsource their cardiovascular billing work to at home billers. Situations like this are fraught with risk since the remote workers are not working in a controlled and monitored environment.
A key battle ground in the struggle to collect all of the money due a cardiologist is appealing denied claims and answering extremely specific and technical questions about procedures and diagnoses. Success In this arena requires significant experience, the kind that is only gained from serving many cardiologists for many years.
A company that does not encompass a wide range of cardiovascular billing experience will find it difficult to track underpayments since multiple procedure rules and cardiovascular procedures have significantly more complicated contractual adjustments than a typical family doctor or internist's claims. In addition, the billing software and system design of a generalist billing company will often be insufficient for the more complicated requirements of reporting and insurance follow-up required in billing for cardiovascular practices.
The cardiology-driven difficulties of medical billing encompass patient billing also. A cardiologist's patient balance process is more challenging because most of the balances are quite sizeable. Coupling this with the difficulties of explaining to a patient their complicated Explanation Of Benefits and the cardiovascular terminology on their bills drives the need for patient collection specialists that have a strong expertise in cardiac billing. If patients are not handles with care then cardiologists will see their patient collections fall and their patient complains rise - not a good combination.
To avoid all these billing related pitfalls cardiologists need to utilize specialized cardiovascular billing services. It is not advisable for an internist to perform heart surgery, similarly someone without training in surgical coding and surgical billing is not qualified to offer reliable billing services for cardiologists.
Copyright 2008 by ClaimCare Medical Billing Services